Fix health systems, solve Ebola crisis, experts say

Training in the district of Kailahun, in eastern Sierra Leone for Red Cross volunteers. They will engage in crucial tasks including social mobilization, contact tracing and body management. (©EC/ECHO/Cyprien Fabre)

BOSTON – The emergency response to the West African Ebola outbreak requires immediate action. And that response means investment in health systems, according to a group of global health organizations based here.

Partners in Health (PIH), Last Mile Project, FACE Africa and the Wellbody Alliance are taking the long view — focusing efforts on overall improvements to health care in Sierra Leone, Guinea and Liberia. On Tuesday, leaders from the groups met to discuss the crisis at an event hosted by the Next Mile Project and New England International Donors.

Panelists argued that donors should be putting their money toward solutions that address the underlying problems behind the prolonged outbreak.

“The underlying cause of the Ebola crisis is a fragile and now-collapsed health system,” said Ophelia Dahl, executive director and president of PIH, in an interview with Humanosphere. “The collapse of health care can leave people exposed to once-managed problems, like polio and measles.”

At least 70 percent of all Ebola patients need to be treated in hospitals before the outbreak turns a corner, according to the U.S. Centers for Disease Control and Prevention. There is a long way to go. In Liberia, for example, just 18 percent of Ebola patients are treated in hospitals or other health facilities.

To make matters worse, evidence is building that the Ebola outbreak is draining the already limited health resources in the three affected countries.

The Last Mile Project and Wellbody Alliance are established organizations in Liberia and Sierra Leone, respectively. The on-the-ground experience and established networks led PIH to partner with Last Mile and Wellbody to bring PIH resources to the Ebola response. Dahl said that roughly 500 medical professionals are signed up to work for PIH in the two countries. The organization, best known for its work in Haiti, is also helping to establish and support the 17 U.S. military-built and staffed clinics.

“There needs to be a community-based system that feeds into a hospital or clinic-based system,” explained Dahl.

She said that the three outbreak countries are missing the community-based half and do not have enough health facilities or medical professionals. PIH and its new partners hope to address the community side with a fleet of health workers. The Wellbody Alliance already has more than 100 community-health workers deployed in Sierra Leone’s Kono District.

Wellbody Executive Director Raphael Frankfurter said that more Ebola cases are pouring into its clinics. “We have experienced a fivefold jump in Ebola cases over the last two weeks,” he said.

Frankfurter told the audience that it was hard to adequately explain how poor health care was in Sierra Leone before the outbreak. One example cited was a request from community maternity clinic to Wellbody for help in getting two boxes of gloves. A medical necessity like gloves were already hard to come by, even before Ebola reached Sierra Leone.

Shortages of basic supplies and hospital beds are making the current response more difficult. But there are other problems that need to be considered, said Frankfurter. People are refusing to go to health clinics or hospitals after getting sick. While stigma and misinformation about Ebola are in part to blame, lack of empathy in the overall response is also at fault.

“People are being treated as disease carriers, not as patients,” he said. “Mothers are told that their sick children have to go to an isolation center for 21 days and provided little other information. It is not surprising that people are scared and confused.”

Creating lasting change for health care means working with the national and local governments to train health workers, build new clinics, improve supply chains and more. But most of the money for the Ebola response is funneled through nongovernment organizations, like PIH. The fact that only 3 percent of donations for Liberia go through the government is troubling to Dahl. That is why it was important for the PIH advance team to meet with Liberian President Ellen Johnson Sirleaf and other government officials to discuss how to work together.

The World Bank, led by PIH co-founder and former Executive Director Dr. Jim Kim, is devoting $400 million to support West African governments in improving health systems. Kim has said numerous times that the underlying problems that make the outbreak worse need to be addressed. Two of which are extreme poverty and inequality, he said in a speech at Howard University, on Wednesday.

“The knowledge and infrastructure to treat the sick and contain the virus exists in high- and middle-income counties. However, over many years, we have failed to make these things accessible to low-income people in Guinea, Liberia and Sierra Leone,” said Kim in his prepared remarks.

“This pandemic shows the deadly cost of unequal access to basic services and the consequences of our failure to fix this problem.”

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Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.